Fish Oil: It Conveys Much More Than Cardiovascular Health

woman jogging at sunrise
Numerous studies have evaluated the effects of the omega-3 fatty acids, DHA and EPA, on cardiovascular health. Overwhelmingly, scientists and clinicians involved in such research believe that omega-3 fatty acids play various beneficial roles in preserving optimal vascular and cardiac health: Anti-Inflammatory, Anti-Thrombotic, Anti-Arrhythmic, and TG-Lowering effects are considered to be the most relevant. Recently, Smith et al. published a fascinating and novel clinical trial looking at a non-cardiovascular yet widespread adverse aspect of aging: muscle mass decline. They published their findings in the American Journal of Clinical Nutrition: Fish oil–derived n–3 PUFA therapy increases muscle mass and function in healthy older adults. All parameters evaluated improved with the administration of 3,200 mg of daily DHA+EPA. Thigh muscle volume, handgrip strength, one-repetition maximum (1-RM) lower- and upper-body strength, and average power during isokinetic leg exercises all demonstrated statistically significant improvement. Improving muscle strength as we age can have far-reaching beneficial consequences that could reduce both morbidity and mortality. Thus, these findings need to be further studied in larger and even more consequential trials. But what additional meaning can we garner from their trial?

I believe that beyond their fascinating and clinically pertinent findings there actually lies a far more evocative message. It is simply that we should be extraordinarily cautious about abandoning the evaluation of therapies (even dietary) when they make biological and physiological sense. Fish oil consumption is woefully low in the US when compared to the far more healthy Japanese population. Our life expectancies are far shorter and various cancers occur more frequently in the US. It is scientifically quite plausible that our deficiency in omega-3 fatty acids plays a significant role in our relatively diminished health. But, after the publication of a few clinical trials failed to demonstrate the cardiovascular benefit of fish and fish oil in select patient populations, some physicians truly abandoned their prior admonitions for patients to augment fish consumption. They were derailed by the controversial results of just a few trials (that many exceptional researchers consider to be flawed in the first place). This type of knee jerk reaction has no place in medicine. It is dangerous and counterproductive. To protect our patients and maintain our scientific integrity, we must always practice with open and attentive minds. Once again I implore my scientific colleagues as well as the oftentimes superficially inquisitive media to follow the science, not the hype.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information about the supplements and vitamins critical to your everyday health visit www.vitalremedymd.com.

Comments { 1 }

Omega-3 Fish Oils – Misleading and Erroneous Interpretations of Scientific Studies Can Cause Harm

Recent statistics demonstrate a small but pervasive decline in national sales of fish oil supplements. Before I continue, let me make it clear that I have a bias here. In 2007 I formulated VitalOils1000, the first omega-3 fish oil carefully and uncompromisingly concentrated and purified so as to enable the American Heart Association’s recommended 1,000 mg of combined EPA and DHA to be placed in a single enteric coated soft gel.

Now, seven years later, VitalOils1000 still stands alone among a sea of fish oil choices (sorry; I couldn’t resist). Needless to say, I am very proud of that accomplishment. So my conflict is clear; I want people to take VitalOils1000. I believe it’s good for them. In fact – that’s why I designed it. So I am disturbed by the decline in people’s consumption of fish oils. Though the “business” ramification of this decline bothers me, I am far more disturbed by its root cause. Falsely frightened people have crumbled under the illusory conclusions of a few poorly constructed trials and the even-more-poorly constructed conclusions derived by “critics” of these trials.

Consider first the fact that four decades of research spanning bedside to bench and back again have demonstrated the sweeping benefits of the omega-3 fatty acids DHA and EPA – fish oil’s “active ingredients”. That’s forty years of thousands of brilliant minds examining the omega-3 issue from a multitude of vantage points. Forty years of overwhelmingly positive conclusions! Then come a few – and I mean a few – poorly designed studies with at times truly ridiculous conclusions. As with most other aspects of news reporting, the negative draws more readers and listeners than the positive. And so the media ran with the story. Some doctors even jumped on the bandwagon. “Fish oil is not what we thought it was,” they concluded. In response, omega-3 experts from around the world voiced their discontent. But their voices were muted as they failed to resonate with fear. The scientists and doctors spoke with authority and knowledge, devoid of histrionics. And so their side of the story didn’t sell newspapers or airtime. The outcome we now witness is that some people prematurely “drank the media cool aide”. They stopped their fish oils.

The problem is that I and many others in this field are left with the great concern that these individuals have left themselves less well protected against a host of disorders than they had been while taking fish oils. Unless they’ve dramatically increased their fatty fish consumption, they have certainly placed themselves in a relative omega-3 deficient state. Think of this: the average American consumes about 100 mg of combined EPA and DHA daily while the average Japanese consumes eight times this amount. And the Japanese have far lower rates of heart disease and prostate cancer than do Americans. Yet, the scant research behind the omega-3 fear mongering cited concerns about the ineffectiveness of omega-3s in cardiovascular disease as well as the possibility of omega-3s predisposing to prostate cancer.

There are many other plausible explanations for these inconclusive trials (see my blog www.fpim.org). Throwing the fish out with the fish water is however not called for. And so my conclusion here is once again to read the primary research. Do you own homework – though it may be hard – and decide for yourself what you think is best. If you need help evaluating the literature, look for the opinions of those who are true leaders in this field – William Harris, PhD, Bruce Holub, PhD, Tom Brenna, PhD, Susan Carlson, PhD (not the owner of the supplement company), and Kevin Maki, PhD for starters. There are plenty of others but be sure to listen to the experts.

Sadly we can no longer rely upon the media’s “Medical Experts” to be our source of scientific veracity. They are too busy, and often forced to weigh in on disciplines far removed from their particular areas of expertise. They cannot possibly be expected to know everything about every medical field. I am sorry to leave you with the task of “doing your own homework”, but nowadays it is something we must all become accustomed to do.

For more information about the supplements and vitamins critical to your everyday health visit www.vitalremedymd.com.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

Comments { 0 }

Beware the Pervasive Reach of Bias – Fish Oil Study Questioned

“Striking a Nerve: Bad Odor to This Fish Oil Study” was the catchy and misleading title for a MedPage headline last week. The “fishy study” to which the cynic refers was published in The American Academy of Neurology. Not exactly a shabby journal. The authors – William Harris, PhD and James Pottala, PhD – erudite and prolific contributors to omega-3 fatty acid research examined the brains of aging women from the Women’s Health Initiative Memory Study and noted a statistically significant association between hippocampal size and omega-3 RBC (Red Blood Cell) levels. In other words, women with low levels of the omega-3s DHA and EPA had more hippocampal atrophy than those with high levels. The importance here is that dementia is frighteningly prevalent (affecting 20% of women) and the hippocampus is likely playing a causal role in its development. Therefore, if we can identify factors – whatever they may be – that prevent hippocampal atrophy, we must pay close attention and examine them further. This is precisely what the authors stated; their findings were encouraging and hypothesis generating. In fact, their final statement, “This study thus adds to the growing literature suggesting that higher omega-3 FA tissue levels, which can be achieved by dietary changes, may hold promise for delaying cognitive aging and/or dementia” does not declare certainty, simply solid hope.

Why then would this study be unfairly condemned? This is a somewhat rhetorical question as I don’t have a clear answer. What I can say with certainty though is that no one should read or listen to an opinion and accept it as fact without first going to the primary source. Everyone would agree this to be true in politics. We must now sadly acknowledge its validity in the world of science as well.

Find more info on the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

Comments { 0 }

Learn to Read the Label: What to Look for When Choosing an Omega-3 Fish Oil Supplement

Omega-3 fish oil supplement labels can be very deceiving. This video explains how to choose the appropriate fish oil supplement.

Get more info on the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

Comments { 0 }

Prostate Cancer and Omega-3 Fish Oils: Beware Conclusions Born of Misinformation

The recent conclusions of Brasky et al must be examined closely as they are not only misleading but potentially dangerous. This statement may appear extreme, but omega-3 fatty acids have been repeatedly shown to protect us against cardiovascular disease (CVD), the leading cause of death in the Western World. Therefore, if men stop eating fish and taking fish oil pills for fear of prostate cancer, they may be putting themselves at risk for CVD, a disorder that kills seven times as many men as does prostate cancer. Such a decision would be not only unwise, but potentially damaging. To better understand this, let’s examine Brasky’s findings in the context of prior data as well as our understanding of the biology of DHA and EPA.

First, many earlier trials have demonstrated a correlation between high fish consumption and low rates of prostate cancer. Some examples are: Lancet, 2001 Terry et al showed a significant correlation between high fish consumption and a low incidence of prostate cancer. The Physician’s Health Study in 2008 revealed a correlation between high fish consumption and improved survival in men with prostate cancer. A 2003 Harvard study of 48,000 men showed a higher intake of fish to be associated with a lower risk of prostate cancer. There are many other examples, but this should suffice.

Second, let’s look at plasma levels of EPA and DHA in Brasky’s trial. The reported EPA+DHA level in the plasma phospholipids was 3.62% in the non-cancer control group and 3.74% in the high-grade cancer group. This difference between controls and the worst cases is extremely small, frankly with no clinical significance.  It is simply within the normal laboratory variation.

Third, is association tantamount to cause? No. Even if there were a clear association between prostate cancer and high EPA and DHA levels, that would not prove causality. Other plausible explanations exist. In fact, this would more likely be a case of reverse causation. We know that two cancer-related phenomena will increase DHA and EPA levels. First, cancerous tissues can upregulate the genes for enzymes that cause long chain fatty acids to “grow” into EPA and DHA – the desaturases and elongases. Second, we know that genetic polymorphisms in the fatty acid desaturases are associated with an increased risk of cancer. So what may be occurring here (if anything is occurring at all) is that cancer-induced changes in desaturases, or cancer-producing genetic polymorphisms in these same enzymes are causing an increase in EPA and DHA. DHA and EPA are not causing the cancers.

Fourth, we are not told the source of omega-3s in this study group. Is it mostly from fish? Some fish have very high levels of PCBs, substances known to be carcinogenic. To conclude that people should stop their fish oil supplements when some supplements are actually far “cleaner” than fish, might therefore be very misguided.

Fifth, let’s examine another population with vastly different omega-3 levels to see whether Brasky’s assertions are relatable to real life. The Japanese consume eight times as much EPA and DHA as do Americans, yet their risk of prostate cancer is about one eighth of ours. If anything, one should conclude that omega-3s are protective here.

Sixth, we can’t ignore the biology of the fatty acids. A plethora of data has demonstrated the anti-inflammatory impact of the omega-3 fatty acids EPA and DHA. Data have also uniformly shown the pro-inflammatory effects of trans-fatty acids. When trial conclusions fly in the face of our understanding of human biology (in this case, trans fats not being harmful while omega-3s causing harm) we must consider them to be highly suspect.

Finally, let’s not forget that EPA and DHA are considered by experts to be “essential” fats. In other words, we must consume them in order to live. Before we discard these indispensable fatty acids, let’s await better clinical trials, and ones that are plausible in the context of prior literature and well-documented pathophysiology.

Additional resource : Dr. Gerald Chodak’s article entitled “Fish Oil’s Link to Prostate Cancer Unproven”  featured on Medscape.

Learn more about the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

Comments { 2 }

A Deeper Look at the Omega-3 Fish Oil Question

man jogging on beach
How many times have we borne witness to the medical recommendations and subsequent reversals and re-reversals of prominent medical societies? In the ‘70s the American Heart Association (AHA) advocated the use of margarine’s hydrogenated oils (trans fats) in place of butter. That, we all now know, was a critical error. The AHA also banned eggs – since reversed – and advocates the use of oils high in omega-6 fatty acids (a recommendation that is currently under significant scrutiny by the scientific community). The AHA has also advised people to eat fish and fish oils. That opinion, still widely held by world leaders in this scientific arena, is now in jeopardy. Last week, Rizos et al published a meta-analysis in the famed Journal of the American Medical Association (JAMA). Rizos findings in a nutshell, omega-3s and fish oil do not help stave off heart disease. There are a number of problems with their trial, but I will limit myself to the two that I consider to be most significant.

First, the statistics. There is a convention in medical science that outcomes are considered to be significant when the p value is < 0.05. In English this means that when the probability that a particular outcome is due to chance is less than 5%, we consider it to be true. A p value of 0.01 (which is less than 0.05) means there’s only a 1% likelihood that a finding is due to chance. This, we consider to be true. On the other hand, a p value of 0.5 means that there’s a 50% possibility that a particular finding is due to chance. We would not consider this finding to be true. You see though, it’s all about possibilities. In reality, we never know that something is true or false, just that it’s likely or not to be true or false. It’s important for you to recognize that our p value designation of 0.05 is considered gospel. Any first year medical student can tell you that. Now consider Rizos’ paper. He performed extraordinarily complex statistical maneuvers and ultimately decided to utilize a p value of 0.0063. That’s correct; he changed convention. By so doing he made the possibility of finding fish oil to be beneficial about 10 times as difficult as it would have been had he stuck to the rules. In fact, had he used a p value of 0.05, the trial would have shown that fish oil indeed does lower cardiovascular death. Instead of the media reporting that fish oil has no value, the headlines would have read, “Take your fish oil. It just might save your life!” That’s because the p value found for cardiovascular death reduction was 0.01, meaning that there is only a 1% possibility that this finding is due to chance, and there is a 99% likelihood it is a real finding! So please don’t stop eating fish or taking fish oil because of this trial’s findings.

Another point of contention is that Rizos described the three cardiovascular benefits of fish oil and omega-3s as: triglyceride-lowering, anti-hypertensive, and anti-arrhythmic. He omitted the two most salient cardiovascular benefits, anti-inflammation and anti-thrombosis (blocking blood clots). He ignored fundamental pathophysiology, an error that I feel can have dire and far-reaching consequences.

In sum, we must not abandon fish oil because of this meta-analysis. So many trials have shown the benefits of omega-3s in myriad medical conditions, such as rheumatologic disorders, cardiovascular disease, macular degeneration, and not least of all, the dementias like Alzheimer’s. Our scientific understanding of the advantages of increasing fish consumption is irrefutable. We cannot afford to repeat the 1970’s misguided AHA initiative for margarine to replace butter. Although doctors on the Today Show and many other popular stations took Rizos’ study at face value and unjustly condemned fish and fish oil, we cannot fall prey to this misinformation.

My advice is to continue your fish and fish oil unless your physician offers a solid reason for you to stop.

Comments { 0 }

Choosing an Omega-3 Fish Oil Supplement

woman on beachI believe one of the keys to enjoying a long and healthful life is a daily program that includes diet, exercise and a regimen of appropriate vitamins, supplements and doctor prescribed medications.

Today I’d like to examine the process of evaluating omega-3 fish oil supplements – products that I believe can enhance and maintain one’s health, and in particular one’s heart health, by potentially reducing the risk of coronary heart disease.

The American Heart Association recommends that individuals with heart disease consume 1000 mg of combined EPA and DHA each day. For those patients who need to lower triglycerides, the AHA recommends 2 to 4 grams of EPA and DHA daily, provided as an omega-3 fish oil supplement in capsule form, under a physician’s care.

With the growing proliferation of omega-3 fish oil products on the market it’s becoming more vital than ever to be an educated consumer. Here are 5 simple things to look for when evaluating a fish oil supplement.

Get the proper dose of EPA and DHA
Choose a fish oil supplement that provides your target dose of combined DHA and EPA (not ALA, omega-6s, or omega-9s). It’s unfortunate that many supplements claim they contain ‘1000 mg fish oils’; a broad term that often misleads consumers who presume the product contains 1000 mg of essential omega-3s, DHA and EPA.

Look for a fish oil capsule that provides the 3:1 ratio of DHA to EPA that replicates the ratio typically found in healthful fish, such as salmon.

Choose a capsule with enteric coating
Choose a capsule that features enteric coating which enhances absorption and typically eliminates any fishy burp or aftertaste. Rosemary extract and vitamin C may be added for superior antioxidant protection.

Choose a purified product
Search out a supplement that has been refined through a process like supercritical fluid technology — a process that gently extracts omega-3s to produce highly concentrated DHA and EPA while most effectively removing contaminants (PCBs, dioxins, furans, and mercury). Also, look for supplements whose manufacturer is certified by international organizations like EMAS, the European standard for environmental care, or similar organizations.

Keeping it green
Choose a fish oil product made from small, non-endangered species of wild fish, such as anchovies, sardines and mackerel, as opposed to those that may be harvesting endangered or over-harvested larger species. Smaller fish also contain fewer toxins that increase in the flesh of larger predatory fish.

Read That Label
Don’t be fooled by labels that claim “1000 mg Fish Oils” but often contain only 30% of the healthful omega-3s, DHA+EPA. The remaining 70% is unnecessary fat. Study the label’s Supplements Facts. How much DHA and EPA are in one serving? How many soft gels make one serving? You might be surprised to learn that you must take 2, 3, or 4 soft gels to get a full 1000 mg of DHA and EPA. If that’s the case, you are getting too much unwanted fat (which can even translate into unintended weight gain).

In sum, be careful about everything you consume. The old adage, “you are what you eat” is definitely true.

Related: Finding the Right Doctor for You

Comments { 3 }

Differentiating Fish Oils Part 3 – DHA and EPA: The Dynamic Duo of Omega-3 Fish Oils

Reading a fish oil supplement label can be a daunting task. Understanding the difference between DHA and EPA, the active ingredients in fish oil, is even more complex. The reason for this complexity resides in the fact that our understanding of these two fatty acids is in its infancy. Still, let’s try to make some sense of what we’ve learned over the past decade or so.

Fatty acids are comprised of just three different atoms, carbon (the long backbone or skeleton of the fatty acid), hydrogen, and oxygen.  That’s it. The difference among the various fats lies in the length of the backbone (how many carbon atoms there are) and the number of “double bonds” between carbon atoms. Other than these two distinctions, the fatty acids are really the same. So, then why are there such great differences among the fats if they’re so similar, you might ask? It turns out that longer chains tend to be more biologically active, and more double bonds results in more twisted and misshapen molecules which can then take on characteristics akin to complex locks or keys. As signaling and communication between cells often occurs through a lock and key mechanism, the fatty acids with many double bonds turn out to be great candidates for this task.

EPA is shorter than DHA (perhaps a bit less biologically active) and has fewer double bonds (less effective as a lock or key). EPA tends therefore to serve more as a precursor for other molecules that can diminish inflammation, clotting, oxidation, and cell death. DHA is also a precursor for some wonderful molecules that cause reversal of inflammation and tremendous protection of nerve tissue. Additionally, DHA is actively incorporated in our cell membranes where it can help cells communicate with other cells.

Other attributes shared by these two omega-3s include: Lowering triglycerides; raising HDL: and lowering the risk of lethal heart rhythms during and following heart attacks. Our bodies contain far more DHA than EPA, and DHA lasts longer in our bodies than does EPA, but both of these fatty acids have very important roles to play, and should be emphasized in our diets.

Visit vitalremedymd.com for more preventive healthcare solutions.

Comments { 1 }

Differentiating Fish Oils Part 2: What’s in your Fish Oil?

So, now that you understand the different forms that fish oils come in, it would be helpful to know what you’re putting in your mouth when you swallow a fish oil soft gel.  To do this, you have to develop the skill of label-reading.  At first blush this may seem to be a simple task, one not worthy of a blog, but in truth deciphering labels can at times be anything but easy.  I am not suggesting that companies intentionally mislead consumers with marketing and catchy phraseology, but at times they certainly don’t go out of their way to clarify what’s being sold to you.  For instance, what does it mean when a label catches your attention with the bold statement, “1,000 mg of fish oil”? Are you to be comforted knowing that taking just one of these pills meets the American Heart Association’s recommendation for heart patients to take 1,000 mg of the essential omega-3s EPA+DHA daily? More often than not, the answer is NO.  That’s because fish oil does not equal EPA+DHA.  And it’s EPA+DHA that you’re after.  EPA and DHA are the active and beneficial ingredients in fish oil, not the other fats (which include saturated fats as well).  To be sure you are getting what you want and deserve, follow these few steps:

  1. Pay attention to only the “Supplement Facts
  2. Read the “Serving size” – how many soft gels does it take to get one serving? Mark that # down.
  3. Read the “Amount per serving” – how much EPA is there, and how much DHA is there in a single serving? Add the amounts of EPA + DHA per single serving. Write that # down. Ignore “other omega-3s’ or “Total omega-3s”
  4. Let’s say your goal is to get 1,000 mg daily of DHA+EPA. Take “1,000” and divide it by the number you got in step 3. For instance, if the number you arrived at is “500 mg”, then 1,000/500 is 2.  You must take 2 servings to get your 1,000 mg of DHA+EPA daily.
  5. But you must be sure how many soft gels make up a single serving! So, now multiply the answer you got in step 4 by the # you got in step 2. For our current example, this will give you the # of pills needed to get your 1,000 mg of DHA+EPA daily. As the serving size can be 1, 2 or even 3 pills, in the case we’ve constructed you might need to take 2, 4, or even six pills to get what you want! That is why this process is so important.

Remember, the more DHA+EPA there is per gram of fish oil, the more concentrated and pure the oil is.  The more pure the oil, the fewer unnecessary fats you are consuming.  Try to get the purest oils. Extra fat gives you extra and unnecessary calories, something most of us do not need these days.

I hope this has been clear and helpful for you. The next blog, Differentiating Fish Oils Part 3, will discuss the different ways our bodies utilize DHA and EPA.

Learn more about the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

Comments { 1 }

Differentiating Fish Oils: Part 1, The Form of the Oil

This series will succinctly describe various aspects of the omega-3 fish oils that cause doctors and their patients a great deal of confusion and consternation. We will begin with the form of the oil.

Fish oils come in four forms: Ethyl Ester (EE), Triglyceride (TG), Phospholipid (PL), and Free Fatty Acid (FFA). Most fish oils (including the prescription, Lovaza) come in the EE form.  In fact, the largest and most profound scientific studies to date have used EE omega-3s.  In nature, omega-3s are found in the TG and PL forms.  The problem is that in order for manufacturers to develop pills with highly concentrated important omega-3s, EPA and DHA (also known as the active ingredients in fish), they must first convert the omega-3s to the EE form.  Then these health-promoting omega-3s can be highly concentrated, and depending upon one’s preference, either EPA or DHA can be emphasized (to be discussed in a future blog). Some manufacturers chose to convert the oils back to the TG form (a process that requires the oils to be subjected to high temperatures for long periods of time – not good for the oils in some experts’ opinions).  Others convert the oils into the FFA form to try to enhance absorption.  The Krill oil producers leave the oil in its original PL form with the drawback being that only very small amounts of the key ingredients EPA and DHA can be delivered in each pill.  The Krill and TG contention is that these forms of omega-3s are more “natural” and thus better.  The reality is, however, that all the oils must be changed in our gut to FFA in order to be absorbed.  Thus, they are no longer PL, TG, or EE when they’re absorbed by our bodies.  They are all FFAs. Studies to date have shown this conversion to be an efficient process and up to 95% absorption can be expected when any of the forms are taken with food. In fact, the lion’s share of the current literature indicates that the form of the oil is probably not nearly as important as companies would like you to believe. The most important issue is how much EPA and DHA you are receiving when you swallow a pill or eat a fish.  That is what you need to look for (also the subject of another blog).

Learn more about the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

Comments { 4 }